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The Impact of Complaints against Doctors: Part 1

Welcome to the first of a series of brief articles about complaints.

My name is Wayne Cunningham. I am a GP and Medicus Board member and have researched and published extensively on the impact of complaints on doctors in New Zealand. By understanding what happens to us when we do receive a complaint (and it will inevitably happen!), we are better placed to care for ourselves, our colleagues and ultimately, our patients.

These articles will consider the various emotional impacts of a complaint, the ‘intellectual’ impact, which is how we process and learn from complaints, and the emergence of what may be the most sinister thing of all, which is defensive medicine and the toll that takes on our practice and on healthcare systems.

But today, some overview ideas that you may find interesting. The first is that NZ doctors respond to complaints in the same way as doctors in litigious cultures such as the USA and Australia.

Responses are the same whether you are complained about or are sued for money. Why so? The answer lies in the idea of shame. Doctors are often shamed by receiving a complaint; they feel that they have failed, are unworthy, and for some, that they should stop practising. And shame underlies many of the emotional and intellectual responses that we will discuss subsequently.

Another interesting idea is that when you sit back and think about it, there are only three things that can go wrong in medicine, and mostly it is when something has been perceived (rightly or not) to have gone wrong, that a complaint follows.

Firstly, systems errors: wrong site surgery, prescribing mistakes, mis-filed results and so on, cause a lot of distress but are often rectifiable. Remember that feeling guilty means that you acknowledge what’s happened and can take steps to rectify it.

Second, wrongdoing, including: unethical or criminal behaviour (think Harold Shipman in the UK or our own Morgan Fahey) is sometimes the cause of a complaint. Don’t be that doctor.

But thirdly, and way more complex, is the issue of medical error. Medical error is what we all fear – ‘getting it wrong’. We fear that decisions made in real time are later pored over interminably, and that we are judged to have failed.

Understanding the epistemology of medicine (how we know what to do) and the limitations of biomedicine are key to getting through this and learning constructively. That is why Medicus is offering members the opportunity for one-on-one review if you receive a complaint, with collegial review rather than doing it all yourself.

In the next issue we will consider doctors’ emotional responses to receiving a complaint, and what to do.


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